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Maryland rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $18.21 / $83.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05